- Date posted
- 1y
Lesser-known treatment options (meds, therapy, procedures)
This message is LONG and extensive, but for people trying to treat OCD for the first time or who have been unsuccessful so far with treatment, I wanted to provide the info I’ve gathered throughout all my research. I separated the options into medications, therapies, and procedures for organization, but combining different forms of treatment is always most effective. MEDICATIONS: — SSRIs: (Zoloft, Paxil, Fluoxetine, Luvox, Prozac, citalopram, escitalopram) These are the go-to meds for OCD as they act specifically on serotonin w/ less side effects compared to other antidepressants. Though many still have bad side effects on these meds, and often SSRIs are nowhere near as effective as they should be. — Clomipramine: This is an older antidepressant called a tricyclic. Some may consider this the first line of treatment for OCD, as far as meds go. It has considerably more side effects than SSRIs since it’s not as specific in what it targets in the brain. Though for whatever reason, clomipramine remains a highly prescribed option. Just make sure to monitor any effects. — Antipsychotics: (Abilify, Risperdal, Seroquel, etc.) These medications are primarily used for bipolar disorder and schizophrenia (Abilify can also be used an add-on if already taking an SSRI). Many of these drugs are known for their action on dopamine, but affect many other neural systems as well. Side effects can be bad, not first line of treatment. — N-acetyl cysteine (NAC): This is actually an amino acid that’s prescribed for respiratory/sinus issues, but it has been shown to possibly have beneficial effects in lessening OCD symptoms. Doses for OCD are higher than for sinuses, and working up may be necessary. The pill sometimes stinks, like it smells, but like come on who cares. — L-Tryptophan: This chemical is a precursor to serotonin, and there has been some evidence to suggest l-tryptophan can alleviate symptoms. However, it would stand to reason that it might make a lot more sense just to take an SSRI, since those act on serotonin already. Taking l-tryptophan will not likely cause any side effects but will not be too very effective. — Ketamine/Esketamine (Spravato): Ketamine is a dissociative anesthetic, so in very high doses it can cause out-of-body sensations and extreme sedation, but it has also been found to be beneficial in treating OCD, displaying fairly impressive rates of symptom reduction. Ketamine acts on a receptor site in your brain called an NMDR glutamate receptor. New meds that affect glutamate are currently being tested, including one that NOCD is testing👀. So this is likely an avenue we’ll see explored more in the future! However right now, insurance does not cover ketamine for OCD, so you’re looking at around $3000-$5000 total for treatment. Esketamine (Spravato) is a nasal spray form of ketamine, and insurance does cover it! Though, ketamine given through an I.V. in a clinical setting is much more effective than nasal esketamine. The chemical structure of the drug and the way it enters your body matter considerably with this treatment. Hopefully ketamine with be covered by insurance for OCD soon. Regardless, please…do not attempt to self-medicate with ketamine. It’s not safe outside of a clinical setting and without proper dosing. THERAPIES: — Exposure/Responsive Prevention therapy (ERP/ExRP): This is the “gold standard” therapy option for treating OCD. It’s most effective when used with cognitive behavioral therapy (CBT), which is next on this list. The patient is exposed to their “triggers,” and this becomes gradually more intense over time. The patient resists the urge to complete a compulsion, and sits with their anxiety until it lessens on its own, hopefully within 15-30 mins. Over time, exposures become more triggering, and the patient is able to do more with less anxiety. The goal is “maximally violating” (I know, it’s bad, I’m sorry) what you hope will happen in a situation. When ERP is used with CBT, the ERP is done first, followed directly by the CBT part of the therapy—the patient thinks through their experience with the exposure, and considers everything they learned from the situation that concerns all the ways that they’re still okay and doing fine. Example: “Oh well, even if my light switch really wasn’t turned off last night, I’m still alive & well, the bulb still works, no electricity fire started, etc….” The ERP is much more effective when used with CBT like this. — Cognitive behavioral therapy (CBT): This form of therapy is much more effective when used with ERP, as mentioned above. But in general, while this therapy doesn’t involve exposure to anxiety, it can help you rewire your mind, changing how you perceive your OCD, what strategies you have to use when you’re really struggling in a moment, and how you take care of yourself. PROCEDURES: — Transcranial Magnetic Stimulation (TMS): This is a relatively new for of treatment initially approved for depression. While it’s not FDA-approved for OCD yet (is incredibly expensive), there is substantial evidence suggesting TMS is beneficial. If you research it, it may sound like electroshock therapy, but this is not the case at all. In CBT, there is a very controlled current sent into a very specific part of the brain, for very specific periods of time, etc. Electroshock therapy was wildly general and didn’t really target anything specific. The currents were also way too high. TMS is a safe and effective treatment option. Just keep your eyes peeled for FDA-approval! — Psychosurgery: I very nearly left this off, as it’s incredibly extreme and is a last-resort for those who can’t function and have tried all other options. Like other procedures, these have become much more controlled, precise, and strategic in recent decades. Though these operations are still very invasive and irreversible. Often, significantly small lesions (areas of cell damage or death) will be made in parts of the brain that are key to OCD. Once neurons are dead, they’re dead, that’s it, bye), so the result is permanent cell death in those areas that should reduce symptoms. Though, again, this is not something surgeons like to do unless is absolutely necessary.